title: Multiple schwannomas of the upper limb related exclusively to the ulnar nerve in a patient with segmental schwannomatosis.
abstract: Schwannomas are benign encapsulated tumours arising from the sheaths of peripheral nerves. They present as slowly enlarging solitary lumps, which may cause neurological defects. Multiple lesions are rare, but occur in patients with neurofibromatosis type 2 or schwannomatosis. Positive outcomes have been reported for surgical excision in solitary schwannomas. However, the role of surgery in patients with multiple lesions is less clear. The risk of complications such as iatrogenic nerve injury and the high likelihood of disease recurrence mean that surgical intervention should be limited to the prevention of progressive neurological deficit. We report a case of a 45 year old male who presented with multiple enlarging masses in the upper limb and sensory deficit in the distribution of the ulnar nerve. The tumours were found to be related exclusively to the ulnar nerve during surgical exploration and excision, a rare phenomenon. The masses were diagnosed as schwannomas following histopathological analysis, allowing our patient to be diagnosed with the rare entity segmental schwannomatosis. One year post-operatively motor function was normal, but intermittent numbness still occurred. Two further asymptomatic schwannomas developed subsequently and were managed conservatively.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Queen Victoria Hospital, Holtye Road, East Grinstead, RH19 3DZ, UK. Electronic address: alexandramolina@doctors.org.uk.
authors.forename: Alexandra R
authors.initials: AR
authors.lastname: Molina
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Chatterton
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Kalson
authors.forename: Mary E
authors.initials: ME
authors.lastname: Fallowfield
authors.forename: Asit R
authors.initials: AR
authors.lastname: Khandwala
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D009442:Neurilemmoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017253:Neurofibromatoses / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D019635:Neurosurgical Procedures; D012878:Skin Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D014459:Ulnar Nerve
keywords: Nerve sheath tumour; Neurilemmomas; Schwannoma; Schwannomatosis; Ulnar nerve